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Insulin Copay Caps Approved in Five More States

April 07, 2020

Insulin Copay Caps Approved in Five More States

When someone needs life-sustaining insulin and cannot afford it, the choices are scary. The ADA has supported increased transparency and more affordable insulin through our work at the federal and state levels. We are urging governors across the country to institute a zero-dollar copayment for insulin during the COVID19 (coronavirus) emergency, and we are also working hard to advance copay cap legislation in states that would set caps on copayments once this emergency is over. We are pleased to report that over the past two weeks, five more states have approved insulin copay cap legislation, which brings the total number  of states with insulin copay caps to seven: Colorado, Illinois, Maine, New Mexico, New York, Utah, Washington, West Virginia.

Maine became the fourth state to approve a copay cap on insulin when Governor Mills signed Legislative Document 2096 into law. The new law caps cost-sharing for insulin at $35 for a 30-day supply, including before a plan’s deductible is met, and applies to state-regulated commercial insurance. This provision takes effect as plans are renewed or issued on or after January 1, 2021. The law also allows for emergency refills for insulin and some associated supplies for those with a previous prescription.

West Virginia’s Governor, Jim Justice, signed insulin copay cap legislation. West Virginia’s House Bill 4543 caps copayments on insulin at $100 total for a 30-day supply. HB 4543 also offers coverage for diabetes self-management education (DSME) and provides a new coverage mandate for blood glucose monitors, monitor supplies, insulin, injection aids, syringes, insulin infusion devices, pharmacological agents for controlling blood sugar, and orthotics. The new law applies to health insurance plans issued or renewed in West Virginia on or after July 1, 2021.

Utah’s Governor, Gary Herbert, signed ADA supported insulin copay cap legislation on March 30. Utah House Bill 207 caps copayments on insulin at $30 for a 30-day supply. The new law, which applies to all state-regulated health plans, also includes an emergency refill provision that will allow people without an up-to-date prescription to get insulin and a provision directing the Utah Department of Insurance to issue a report that includes a summary of insulin pricing practices. HB 207 takes effect on January 1, 2021.

Washington’s Governor, Jay Inslee, signed Senate Bill 6087, legislation that caps copayments on insulin at $100 total for a 30-day supply, insulin is covered without being subject to a deductible, and any cost sharing paid by an enrollee must be applied toward the enrollee's deductible. This law applies to both state-regulated commercial insurance and public employee plans. SB 6087 takes effect on January 1, 2021.

And in New York, Governor Cuomo signed into law an insulin copay cap that was part of one of the state budget bills (Part DDD of S7506-B/A9506-B).  The insulin copay cap of $100 applies to state-regulated commercial health insurance plans, and the $100 cap also applies before the person with diabetes has met their health plan deductible. The $100 copay cap law will take effect as health plans are issued or renewed on January 1, 2021.

In Virginia, ADA-supported legislation capping insulin copayments also passed the legislature and is awaiting gubernatorial action.

For more information about New York’s and Maine’s laws, please contact Stephen Habbe, Director of State Government Affairs at shabbe@diabetes.org and for information about West Virginia’s law, please contact Gary Dougherty, Director of State Government Affairs at gdougherty@diabetes.org. For more information about the new laws in Utah and Washington, please contact Laura Keller, Director of State Government Affairs at lkeller@diabetes.org.